Provider Demographics
NPI:1750829925
Name:PAFFORD HEALTH
Entity Type:Organization
Organization Name:PAFFORD HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-279-2148
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96104-0267
Mailing Address - Country:US
Mailing Address - Phone:530-279-2148
Mailing Address - Fax:530-240-6440
Practice Address - Street 1:519A MAIN STREET
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:CA
Practice Address - Zip Code:96104
Practice Address - Country:US
Practice Address - Phone:530-279-2148
Practice Address - Fax:530-240-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5851798532Medicare PIN